For the better part of this century, the Centers for Disease Control and Prevention (CDC) have reported the leading cause of death as heart disease. In women’s cases, however, there are diagnostic challenges and increased risk factors associated with heart disease. In honor of Heart Health Month (February), three UC San Diego Health professionals spoke about heart disease, Feb. 15 at the Altman Clinical & Translational Research Institute on campus.

Cardiothoracic surgeon Joelle Coletta said the common risk factors for heart disease include smoking (but women have a 25 percent higher incidence of cardiovascular disease than male smokers); obesity and hypertension (which tend to be an issue for women post-menopause); and elevated cholesterol (women are less likely to be prescribed a statin [cholesterol-reducing drug] even if they have the same cholesterol problems as men.

In short, she said: “Women pay a higher penalty for the same risk factors.”

Other heart-health risk factors particular to women, she said, include: pregnancy-associated issues, including preeclampsia and gestational diabetes; auto-immune diseases such as lupus or rheumatoid arthritis, which affect women more often than men; depression, which some people don’t think of as being related, but depression has been shown to be a risk (considering its association with other risk factors such as smoking or obesity); radiation therapy for breast cancer, which can cause changes in the muscle and valves; and hormone replacement therapy for menopause.

“Additionally, for women, the symptoms that manifest aren’t the typical symptoms such as crushing chest pressure,” she said. “For women, it might be a general sense of nausea, shortness of breath ... more vague symptoms. This can cause delays in diagnoses.”

Coletta also discussed the advancements in surgical options and treatments.

Atrial fibrillation

Delving into more specific fields, cardiologist Ulrika Birgersdotter-Green, Director of Pacemaker & ICD Services, talked about atrial fibrillation (AF); and Pam Taub, cardiologist and Director of Cardiovascular Rehabilitation and Wellness Center, talked about the programs and services offered at the new center. The common thread linking their presentations — some heart disease is preventable and lifestyle modifications play a big part.

Birgersdotter-Green explained that AF is an irregular, often fast, heart rhythm. “We’re all going to get AF, and I say that with only a slight exaggeration,” she said. “It is far and above the most common heart rhythm problem we see. About a third of all heart rhythm problems put people in the hospital for AF. Hospital admissions for AF have increased 66 percent in the last 20 years.”

She added that the increase is likely due to people living longer, as age is a risk-factor. “Most AF patients are at risk for stroke, and AF-related strokes tend to be large and disabling,” Birgersdotter-Green pointed out. “Symptoms include the feeling of your heart beating out of your chest. It can come with shortness of breath and chest pains, but for most people, it is a rapid heartbeat. In some people, it is asymptomatic.”

There are different types of AF, she said: paroxysmal AF, which lasts for two hours and goes away on its own; persistent AF, which starts and doesn’t go away by itself and needs medical intervention; and permanent AF, which is AF that keeps coming back and patients live with it.

There are two groups of AF risk factors, she continued, ones that can be curtailed and ones that are unavoidable. Two risk factors that cannot be slowed include getting older and having a genetic component that affects some people. Factors that can be addressed to deter AF include high blood pressure, heart failure, diabetes, heart disease, high cholesterol and overactive thyroid.

“We can do a lot of things for our patients, but patients have to do a lot of things on their own,” Birgersdotter-Green said. “If we all want to reduce our risk of AF, it’s all about checking our blood pressure, making sure we treat or prevent diabetes, and exercising. These things will make a difference.”

Beat a path to wellness

Taub, in discussing the programs of the Cardiac Rehabilitation & Wellness Center, echoed that healthy lifestyle modifications include stress reduction, diet, exercise and social support.“These address the systemic nature of the disease, instead of just applying bandages,” she said.

Of particular interest in this field is “visceral fat,” she said, which is not the fat under the skin you can pinch, but the fat that hides around organs and is related to inflammation and cardiovascular risk.

“One of the few things that reduces visceral fat is high-intensity interval training, which is when you get your heart rate up for a short period of time, then bring it back down, and then back up again. But a lot of our patients who have just had a heart attack, do not feel safe doing that,” Taub explained.

She said care providers at the Center, monitor patients and help them exercise safely. “For many people, heart disease is preventable. So much of what we eat can be our medicine. I see patients that come in with all these supplements and I encourage them to just eat foods that contain the vitamins.